Well Child Care, 3- to 5-Day-Old

NORMAL NEWBORN BEHAVIOR AND CARE

Your baby should move both arms and legs equally and need support for his or her head.

Your baby will sleep most of the time, waking to feed or for diaper changes.

Your baby can indicate needs by crying.

The newborn baby startles to loud noises or sudden movement.

Newborn babies frequently sneeze and hiccup. Sneezing does not mean your baby has a cold.

Many babies develop jaundice, a yellow color to the skin, in the first week of life. As long as this condition is mild, it does not require any treatment, but it should be checked by your health care provider.

The skin may appear dry, flaky, or peeling. Small red blotches on the face and chest are common.

Your baby's cord should be dry and fall off by about 10–14 days. Keep the belly button clean and dry.

A white or blood tinged discharge from the female baby's vagina is common. If the newborn boy is not circumcised, do not try to pull the foreskin back. If the baby boy has been circumcised, keep the foreskin pulled back, and clean the tip of the penis. A yellow crusting of the circumcised penis is normal in the first week.

To prevent diaper rash, keep your baby clean and dry. Over-the-counter diaper creams and ointments may be used if the diaper area becomes irritated. Avoid diaper wipes that contain alcohol or irritating substances.

Babies should get a brief sponge bath until the cord falls off. When the cord comes off and the skin has sealed over the navel, the baby can be placed in a bath tub. Be careful, babies are very slippery when wet. Babies do not need a bath every day, but if they seem to enjoy bathing, this is fine. You can apply a mild lubricating lotion or cream after bathing.

Clean the outer ear with a wash cloth or cotton swab, but never insert cotton swabs into the baby's ear canal. Ear wax will loosen and drain from the ear over time. If cotton swabs are inserted into the ear canal, the wax can become packed in, dry out, and be hard to remove.

Clean the baby's scalp with shampoo every 1–2 days. Gently scrub the scalp all over, using a wash cloth or a soft bristled brush. A new soft bristled toothbrush can be used. This gentle scrubbing can prevent the development of cradle cap, which is thick, dry, scaly skin on the scalp.

Clean the baby's gums gently with a soft cloth or piece of gauze once or twice a day.

RECOMMENDED IMMUNIZATION

A newborn should have received the birth dose of hepatitis B vaccine prior to discharge from the hospital. Infants who did not receive this birth dose should obtain the first dose as soon as possible. If the baby's mother has hepatitis B, the baby should have received an injection of hepatitis B immune globulin in addition to the first dose of hepatitis B vaccine during the hospital stay, or within 7 days of life.

TESTING

All babies should have received newborn metabolic screening, sometimes referred to as the state infant screen (PKU), before leaving the hospital. This test is required by state law and checks for many serious inherited or metabolic conditions. Depending upon the baby's age at the time of discharge from the hospital or birthing center, a second metabolic screen may be required. Check with the baby's health care provider about whether your baby needs another screen. This testing is very important to detect medical problems or conditions as early as possible and may save the baby's life. The baby's hearing should also have been checked before discharge from the hospital.

BREASTFEEDING

Breastfeeding is the preferred method of feeding for virtually all babies and promotes the best growth, development, and prevention of illness. Health care providers recommend exclusive breastfeeding (no formula, water, or solids) for about 6 months of life.

Breastfeeding is cheap, provides the best nutrition, and breast milk is always available, at the proper temperature, and ready-to-feed.

Babies often breastfeed up to every 2–3 hours around the clock. Your baby's feeding may vary. Notify your baby's health care provider if you are having any trouble breastfeeding, or if you have sore nipples or pain with breastfeeding. Babies do not require formula after breastfeeding when they are breastfeeding well. Infant formula may interfere with the baby learning to breastfeed well and may decrease the mother's milk supply.

Babies who get only breast milk or drink less than 16 ounces (480 mL) of formula each day may require vitamin D supplements.

FORMULA FEEDING

If the baby is not being breastfed, iron-fortified infant formula may be provided.

Powdered formula is the cheapest way to buy formula and is mixed by adding one scoop of powder to every 2 ounces (60 mL) of water. Formula also can be purchased as a liquid concentrate, mixing equal amounts of concentrate and water. Ready-to-feed formula is available, but it is very expensive.

Formula should be kept refrigerated after mixing. Once the baby drinks from the bottle and finishes the feeding, throw away any remaining formula.

Warming of refrigerated formula may be accomplished by placing the bottle in a container of warm water. Never heat the baby's bottle in the microwave, because this can cause burns in the baby's mouth.

Clean tap water may be used for formula preparation. Always run cold water from the tap for a few seconds before use for your baby's formula.

For families who prefer to use bottled water, nursery water (baby water with fluoride) may be found in the baby formula and food aisle of the local grocery store.

Well water used for formula preparation should be tested for nitrates, boiled, and cooled for safety.

Bottles and nipples should be washed in hot, soapy water, or may be cleaned in the dishwasher.

Formula and bottles do not need sterilization if the water supply is safe.

The newborn baby should not get any water, juice, or solid foods.

ELIMINATION

Breastfed babies have a soft, yellow stool after most feedings, beginning about the time that the mother's milk supply increases. Formula fed babies typically have one or two stools a day during the early weeks of life. Both breastfed and formula fed babies may develop less frequent stools after the first 2–3 weeks of life. It is normal for babies to appear to grunt or strain or develop a red face as they pass their bowel movements.

Babies have at least 1–2 wet diapers each day in the first few days of life. By day 5, most babies wet about 6–8 times each day, with clear or pale, yellow urine.

SLEEP

Always place your baby to sleep on his or her back. "Back to Sleep" reduces the chance of SIDS, or crib death.

Do not place the baby in a bed with pillows, loose comforters or blankets, or stuffed toys.

Babies are safest when sleeping in their own sleep space. A bassinet or crib placed beside the parent bed allows easy access to the baby at night.

Never allow your baby to share a bed with older children or with adults.

Never place babies to sleep on water beds, couches, or bean bags, which can conform to the baby's face.

PARENTING TIPS

Newborn babies cannot be spoiled. They need frequent holding, cuddling, and interaction to develop social skills and emotional attachment to their parents and caregivers. Talk and sing to your baby regularly. Newborn babies enjoy gentle rocking movement to soothe them.

Use mild skin care products on your baby. Avoid products with smells or color, because they may irritate your baby's sensitive skin. Use a mild baby detergent on the baby's clothes and avoid fabric softener.

Always call your health care provider if your child shows any signs of illness or has a fever (temperature higher than 100.4° F [38° C]). It is not necessary to take the temperature unless your baby is acting ill. Do not treat with over-the-counter medications without calling your health care provider. If your baby stops breathing, turns blue, or is unresponsive, call 911. If your baby becomes very yellow, or jaundiced, call your baby's health care provider immediately.

SAFETY

Make sure that your home is a safe environment for your baby. Set your home water heater at 120° F (49° C).

Provide a tobacco-free and drug-free environment for your baby.

Do not leave the baby unattended on any high surfaces.

Do not use a hand-me-down or antique crib. The crib should meet safety standards and should have slats no more than 2⅜ inches (6 cm) apart.

Your baby should always be restrained in an appropriate child safety seat in the middle of the back seat of your vehicle. Your baby should be positioned to face backward until he or she is at least 2 years old or until he or she is heavier or taller than the maximum weight or height recommended in the safety seat instructions. The car seat should never be placed in the front seat of a vehicle with front-seat air bags.

Equip your home with smoke detectors and change batteries regularly.

Be careful when handling liquids and sharp objects around young babies.

Always provide direct supervision of your baby at all times, including bath time. Do not expect older children to supervise the baby.

Newborn babies should not be left in the sunlight and should be protected from brief sun exposure by covering with clothing, hats, and other blankets or umbrellas.

WHAT'S NEXT?

Your next visit should be at 1 month of age. Your health care provider may recommend an earlier visit if your baby has jaundice, a yellow color to the skin, or is having any feeding problems.